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Chirurgia 2005 December;18(6):465-8

language: Italian

The topographic anatomy imprevedibility: limitative factor for the videolaparoscopic approach in biliary surgery

Caputo P., Santamaria A., Giorgetta C., Morzenti S., Gambini D., Bonandrini L.


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The videolaparoscopic surgery is considered the gold standard for the operation of cholecystectomy in case of lithiasic gallbladder. The preoperative examination studies the gallbladder morphology accurately but not equally the topographic anatomy. Only in a limited number of cases, specific preoperative examinations are performed, such as the magnetic resonance cholangiography and the endoscopic retrograde cholangiopancreatography, that allow to highlight anatomic alterations. Therefore, it is frequent to find during the videolaparoscopic surgical operation variation of the topographic anatomy that does not allow the correct recognition of the Calot's triangle elements. In these cases, the videolaparoscopic approach is limitant: in our experience in 4 cases out of 10 we opted for the traditional surgical approach. The tridimensional vision and the use of touch are the major advantages of open surgery. In conclusion, we consider the videolaparoscopy a second rate surgical approach in case of anatomic alterations of the Calot's triangle elements and the physiological topographic anatomy.

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